Are there any further modalities for prediction of subclinical volume overload in advanced stages of chronic kidney disease?

Background@#Subclinical volume overload in chronic kidney disease (CKD) patient represents a debatable issue. Although many tools were used to detect volume overload in such patients, many non-specific results were due to presence of comorbidities. Bioimpedance spectroscopy is an objective fluid status assessment method, which is shown superior to classical methods in many studies. Combining some of these tools may improve their accuracy and specificity. Inferior vena cava collapsibility index (IVCCI) with brain natriuretic peptide (BNP) can be combined for more specific volume assessment. This study was performed to assess the usage of combined IVCCI and BNP levels in CKD patients to predict subclinical volume overload. @*Methods@#One hundred and ten patients with CKD (stages 4 and 5) not on dialysis and having normal left ventricular systolic function were included in this study. Exclusion criteria were: (1) patients with other causes of raised BNP than volume overload and (2) patients on diuretics. A complete medical history was obtained, and thorough examination and laboratory tests were performed for all included patients. IVCCI and BNP serum levels were evaluated. The patients who exhibited an overhydration (OH)/extracellular water (ECW) ratio of >15% were considered to have volume overload. @*Results@#Twenty-six patients (23.6%) had subclinical hypervolemia as diagnosed by OH/ECW ratio of >15%. IVCCI ≤ 38% had higher diagnostic performance than BNP ≥ 24 pg/mL. Combining both IVCCI ≤ 38% and BNP ≥ 24 pg/mL increased the specificity and positive predictive value for detection of subclinical hypervolemia. @*Conclusion@#Combined elevated BNP level and decreased IVCCI are more precise tools for subclinical volume overload detection in CKD patients.

Are there any further modalities for prediction of subclinical volume overload in advanced stages of chronic kidney disease?

Background@#Subclinical volume overload in chronic kidney disease (CKD) patient represents a debatable issue. Although many tools were used to detect volume overload in such patients, many non-specific results were due to presence of comorbidities. Bioimpedance spectroscopy is an objective fluid status assessment method, which is shown superior to classical methods in many studies. Combining some of these tools may improve their accuracy and specificity. Inferior vena cava collapsibility index (IVCCI) with brain natriuretic peptide (BNP) can be combined for more specific volume assessment. This study was performed to assess the usage of combined IVCCI and BNP levels in CKD patients to predict subclinical volume overload. @*Methods@#One hundred and ten patients with CKD (stages 4 and 5) not on dialysis and having normal left ventricular systolic function were included in this study. Exclusion criteria were: (1) patients with other causes of raised BNP than volume overload and (2) patients on diuretics. A complete medical history was obtained, and thorough examination and laboratory tests were performed for all included patients. IVCCI and BNP serum levels were evaluated. The patients who exhibited an overhydration (OH)/extracellular water (ECW) ratio of >15% were considered to have volume overload. @*Results@#Twenty-six patients (23.6%) had subclinical hypervolemia as diagnosed by OH/ECW ratio of >15%. IVCCI ≤ 38% had higher diagnostic performance than BNP ≥ 24 pg/mL. Combining both IVCCI ≤ 38% and BNP ≥ 24 pg/mL increased the specificity and positive predictive value for detection of subclinical hypervolemia. @*Conclusion@#Combined elevated BNP level and decreased IVCCI are more precise tools for subclinical volume overload detection in CKD patients.

Efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with hepatitis C

Background and aim: H.C.V. is prevalent in H.D. patients with variable rates from 1-4% in Japan and UK, 7-10% in U.S., 10-15 in Central Europe up to 60-80% in South America and Middle East countries. These patients experience more side-effects with anti-H.C.V. treatment. The aim of this study was to evaluate the efficacy and tolerability of pegylated interferon [PEG-IFN] alpha-2a in chronic hemodialysis patients with chronic hepatitis C infection

Methods: Thirty five patients were included into the study. All of the patients were interferon naive, anti-HCV abs positive and PCR HCV-RNA positive. 20 of the patients maintained on PEG-IFN alpha-2a at a dose of 135 micro g weekly subcutaneous [sc] aiming at 48 weeks treatment course duration [Gr. 1], two patients had died during the 1[st] 2 months one because of road traffic accident and the other because of acute coronary event [AMI], another 3 patients had been withdrawn from the study because of non compliance [drop out rate 25%], so 15 patients had completed the treatment course as group 1, and the other 15 patients received no specific treatment and were used as controls [Gr. 2]. The 2 groups were prospectively followed up for a period of 18 months. Biochemical and virological responses were evaluated at the end of the study period [end of treatment response] and 6 months after completion of therapy [sustained response]

Results: Virological end of treatment response was observed in 12 patients [80%] in Group 1 and one patient [6.6%] in Group 2 [P< 0.001] sustained virological response was observed in 11 patients [73.3%] in Group 1 and one patient [6.6%] in Group 2 [P< 0.001]. Even if most of the patients experienced several side effects [anemia 73.3% fatigue 66.6%, thrombocytopenia 40% and leucopenia 33.3%], they did not impose the discontinuation of the treatment

Conclusion: The present study showed that PEG-IFN alpha-2a for 48 weeks is efficacious and well tolerated in hemodialysis patients with HCV

Gabapentin and uremic pruritus in hemodialysis patients

Pruritus is a common problem in dialysis patients and despite the advances in its treatment it remained a distressing sometimes disabling for those patients. Gabapentin is an effective drug in the management of neuropathic pain syndromes. Considering a similar pathogenic mechanisms, we conducted our study to evaluate the efficacy and safety of gabapentin in controlling uremic itch in HD patients. In a double blind, placebo-controlled trial, 45 adult patients on maintenance HD were enrolled. The included patients were assigned to receive four weeks of treatment with either gabapentin [300 mg] or placebo administered thrice weekly after HD sessions. Pruritus scores were measured using a visual analogue scale and compared between the two groups. After four weeks of treatment, the mean decrease in itch score in gabapentin and placebo groups was 7.4 +/- 2.18 and 1.0 +/- 0.5, respectively [P < 0.001]. None of our patients was forced to drop out of the study because of gabapentin side effects. Our study suggests that gabapentin is effective and relatively safe in the treatment of uremic Pruritus for patients under hemodialysis [HD]

Clinical anatomy of the inferior turbinate

This study was conducted to examine the anatomical configuration of the inferior turbinate, so that its abnormalities can be handled accurately during sinus surgery. The inferior turbinate and meatus were studied radiologically through CT scan films in 30 normal adult individuals and anatomically in the postmortem room in 5 cadavers died from other pathology than nasal disease. The results showed variations in the attachment and shape of the skeleton and soft tissue of the turbinate and its vessels throughout its anteroposterior dimension. Variations were also found in the shape of attachment of the uncinate process to the inferior turbinate

Functional endoscopic sinus surgery

The anterior ethmoid plays an important role in the pathogenesis of chronic maxillary and frontal sinusitis. Nasal endoscopy enables us not only to diagnose chronic ethmoiditis but also to perform endoscopic ethmoidectomy visual control. This work comprised 60 patients of chronic ethmoiditis for whom 87 operations of functional endoscopic sinus surgery were performed. The procedure comprised endoscopic clearance of the osteomeatal area [anterior ethmoid-middle meatus complex] with middle meatal antrostomy if indicated. Follow-up of these cases for periods ranging between 4 and 18 months resulted in symptomatic improvement in 96.7% of the cases with 97.55% endoscopically free ethmoid cavities. It is concluded that functional endoscopic sinus surgery is a procedure with reasonably good results

Chronic and recurrent otitis media in chronic sinusitis

The middle ear is dependent on a functioning eustachian tube which in retum is dependent on healthy nose, nasopharynx and paranasal sinuses. This study comprised 50 cases of chronic sinusitis and 50 nasally free individuals as control. They were subjected to nasal and nasopharyngeal endoscopy as well as audiometry and tympanometry. It was found that 54.9% of the cases of chronic sinusitis were associated with chronic otitis media while only 5% of the control group were associated with chronic otitis media. Nasopharyngoscopy showed that in 46.47% of the cases of chronic sinusitis which were associated with chronic otitis media, pus or mucopus could be traced passing from the middle meatus of the affected side or sides along the eustachian tube orifices. These findings support the concept that chronic sinusitis may act as a source of infection and reinfection to the middle ear. This should be considered in the treatment of chronic and recurrent otitis media